It’s Corporate Compliance Week: Fraud and abuse – a quality of care issue

November 7, 2018  //  FOUND IN: Updates & Resources

When you hear “compliance,” you probably think about HIPAA privacy and security.

But the earliest health care compliance efforts, which began in the 1990s, actually focused on Revenue Cycle issues.

Health care providers face enormous financial pressures, and Michigan Medicine is no exception. However, faculty and staff must never lose sight of their obligation to accurately document the services they provide, and they must conduct all financial transactions — including coding, billing, reimbursement and referrals — in a legal and ethical manner.

Examples of fraud and abuse include incomplete or inaccurate documentation, altering documents to gain higher payment, misrepresenting dates and descriptions of services, and not providing patients with notice about appropriate payment responsibilities or appeal rights.

Such violations of state and federal fraud and abuse statutes carry harsh legal consequences, including the potential for heavy fines and exclusion from the Medicare program.

There are other serious consequences beyond fines and penalties, though, including reputational harm to the university, Michigan Medicine and its providers.

More importantly, Revenue Cycle compliance directly affects quality of care and patient safety and satisfaction. Inaccurate documentation can cause medical errors and misunderstanding of payment obligations, leading to patient dissatisfaction, concerns about questionable ethical practices and potential loss of trust.

Remember, compliance — including Revenue Cycle compliance — is above all a quality of care issue.